Spinal cord

Question 1

Define syringomyelia

Answer 1

A condition in which an abnormal fluid filled cavity develops within the central canal of the spinal cord -> compression on the medial structures

Question 2

Describe the presentation of syringomyelia

Answer 2

Compression of the spinothalamic tract causes reduced sensation of pain and temperature in cape-like distribution

• LMN signs at level of lesion (usually arms) eg. wasting, fasciculations
• UMN signs below lesion (legs)

Question 3

What are the RFs for syringomyelia?

Answer 3

Chiari malformation
Previous spinal cord injury
Hx of infection, inflammation to spinal cord

Question 4

How is syringomyelia diagnosed?

Answer 4

MRI spine

Question 5

What are some causes of spinal cord compression?

Answer 5

Trauma is most common
Vascular:
Infectious/inflammatory: discitis, abscesses
Metabolic: bone disease eg. OP
Neoplastic: benign vs malignant bone tumours eg. myeloma
Disc prolapse

Question 6

Describe the presentation of spinal cord compression

Answer 6

Depends on the level of the lesion and the area of the spinal cord affected

eg. anterior cord: interrupted spinothalamic and corticospinal tracts vs posterior cord: dorsal columns
- LMN signs at level of lesion, UMN below
- Autonomic symptoms: constipation, retention, ED
- Radiculopathy

Question 7

What is spinal stenosis? Describe the presentation

Answer 7

Spinal stenosis occurs when there is narrowing of the spinal canal, usually due to degenerative disease
Presents w neurogenic claudication and radiculopathy
-Numbness, weakness, pain on walking. Relieved by sitting
-Back pain and radiculopathy
-Usually no neurological deficits!!

Question 8

How is spinal stenosis diagnosed?

Answer 8

MRI spine

Question 9

What is the management of spinal stenosis?

Answer 9

Conservative:
-Physio

Medical:

• Analgesia: NSAIDs, TCAs, gabapentin
• Steroid injection

Surgical

Question 10

What is cauda equina syndrome?

Answer 10

Compression of the cauda equina (below L1/2)

• Low back pain
• Saddle anaesthesia
• Urinary/bowel incontinence
• Poor anal tone
• Bilateral sciatica (radiculopathy)
• Reduced reflexes, weakness, flaccid muscles

Question 11

What are the signs/symptoms of conus medullaris?

Answer 11

Similar to cauda equina syndrome but:

• Back pain > radicular pain
• Mixed UMN and LMN signs

Question 12

Describe the management of spinal cord compression

Answer 12

Depends on the cause eg.

• Traumatic: surgical decompression
• Cauda equina: surgical decompression
• Metastases: medical (dex, radiotherapy), surgical

Question 13

What are signs of malignant spinal cord compression?

Answer 13

Progressively worsening pain
Unremitting pain
Pain aggravated by straining
Nocturnal pain 
Neurological deficits

Question 14

Describe the diagnosis of suspected MSCC

Answer 14

If presenting with suggestive pain: MRI spine within 1 week

Pain + neuro: MRI spine within 24 hours

Question 15

Describe the treatment options for spinal metastases

Answer 15

Medical:
-Analgesia: NSAIDs, opioids
-Bisphosphonates: specifically breast, myeloma, prostate
-Radiotherapy for pain
Surgical

Question 16

Describe the treatment options for MSCC

Answer 16

Medical:
-Analgesia
-Corticosteroids: 16mg dex
-Radiotherapy
Surgical: decompression and stabilisation